Provider Demographics
NPI:1295176527
Name:PUTIGNANO, DIANA RENEE (ATC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:RENEE
Last Name:PUTIGNANO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:RENEE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8930 VILLAGE AVE
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-2129
Mailing Address - Country:US
Mailing Address - Phone:818-767-8382
Mailing Address - Fax:
Practice Address - Street 1:8930 VILLAGE AVE
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-2129
Practice Address - Country:US
Practice Address - Phone:818-767-8382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0704026102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer